Objectives:To assess preferences for colorectal cancer (CRC) screening modes in a representative sample of VA patients and to identify demographic, attitudinal, and health factor variables associated with these preferences.

Methods:3,025 patients age 50-75 from 24 VA facilities responded to a mail survey with phone follow-up (response rate 83%). In addition to indicating their preferred mode of CRC screening, participants answered questions regarding their attitudes about CRC, past CRC screening behavior, family history of CRC, overall health, and demographics. Personal history of bowel disease was obtained through administrative data. The distribution of screening mode preferences was reported separately for average-risk (no personal history of CRC or family history of bowel disease) and high-risk participants. Predictors of preference for no screening versus screening and for fecal occult blood test (FOBT) versus endoscopy were determined through a series of hierarchical logistic regressions.

Results:Among average-risk veterans, colonoscopy was most preferred (37%) followed by FOBT (29%), don’t know/no response (22%), sigmoidoscopy (5%), no testing (4%), and barium enema (2%). Predictors of preference for FOBT over endoscopy included lower income, high endoscopy anxiety, belief that CRC screening is unimportant, low social pressure to be screened, having never completed an endoscopy, and having previously completed an FOBT. Older veterans were more likely to choose no testing as were veterans who felt that screening was unimportant, who had low screening self-efficacy, or had never completed an FOBT. Among high-risk participants, 61% chose colonoscopy. High-risk veterans choosing FOBT over endoscopy had lower income, felt they were less susceptible to CRC, had lower screening self-efficacy, and had more endoscopic anxiety.

Implications:Colonoscopy was the most preferred CRC screening mode, however preferences were heterogeneous even among veterans at high risk of CRC, for whom guidelines recommend colonoscopy. Both average and high-risk veterans preferring FOBT tend to have lower incomes and feel greater endoscopic anxiety.

Impacts:As more VA sites begin to offer screening colonoscopy, these results provide a basis for projecting demand. Screening rates may be improved by emphasizing FOBT as an option to those who initially prefer no screening.